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Abdalla TSA, Pieper L, Kist M, Thomaschewski M, Klinkhammer-Schalke M, Zeissig SR, Tol KKV, Wellner UF, Keck T, Hummel R. Gastrointestinal stromal tumors of the upper GI tract: population-based analysis of epidemiology, treatment and outcome based on data from the German Clinical Cancer Registry Group. J Cancer Res Clin Oncol 2023; 149:7461-7469. [PMID: 36959341 PMCID: PMC10374476 DOI: 10.1007/s00432-023-04690-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. They are most frequently located in the stomach but are also found in the esophagus and the gastroesophageal junction (GEJ). Information regarding the prognostic factors associated with upper gastrointestinal GIST is still scarse. METHODS In this study, datasets provided by the German Clinical Cancer Registry Group, including a total of 93,069 patients with malignant tumors in the upper GI tract (C15, C16) between 2000 and 2016 were analyzed to investigate clinical outcomes of GIST in the entire upper GI tract. RESULTS We identified 1361 patients with GIST of the upper GI tract. Tumors were located in the esophagus in 37(2.7%) patients, at the GEJ in 70 (5.1%) patients, and in the stomach in 1254 (91.2%) patients. The incidence of GIST increased over time, reaching 5% of all UGI tumors in 2015. The median age was 69 years. The incidence of GIST was similar between males and females (53% vs 47%, respectively). However, the proportion of GIST in female patients increased continuously with advancing age, ranging from 34.7% (41-50 years) to 71.4% (91-100 years). Male patients were twice as likely to develop tumors in the esophagus and GEJ compared to females (3.4% vs. 1.9% and 6.7% vs. 3.4%, respectively). The median overall survival of upper gastrointestinal GIST was 129 months. The 1-year, 5-year, and 10-year OS was 93%, 79%, and 52% respectively. Nevertheless, tumors located in the esophagus and GEJ were associated with shorter OS compared to gastric GIST (130 vs. 111 months, p = 0.001). The incidence of documented distant metastasis increased with more proximal location of GIST (gastric vs. GEJ vs. esophagus: 13% vs. 16% vs. 27%) at presentation. CONCLUSION GIST of the esophagus and GEJ are rare soft tissue sarcomas with increasing incidence in Germany. They are characterized by worse survival outcomes and increased risk of metastasis compared to gastric GIST.
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Affiliation(s)
- Thaer S A Abdalla
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany.
| | - Lina Pieper
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Markus Kist
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Michael Thomaschewski
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Monika Klinkhammer-Schalke
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality and Research in Oncology (ADT), Berlin, Germany
| | - Sylke Ruth Zeissig
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality and Research in Oncology (ADT), Berlin, Germany
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Kees Kleihues-van Tol
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality and Research in Oncology (ADT), Berlin, Germany
| | - Ulrich Friedrich Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Richard Hummel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany.
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Kumar K, Patel H, Mehershahi S, Tariq H, Glandt M, Erfani M, Dev A, Zhang A, Makker J. Clinical relevance of endoscopically identified extrinsic compression of the oesophagus and stomach. BMJ Open Gastroenterol 2019; 6:e000310. [PMID: 31413857 PMCID: PMC6673764 DOI: 10.1136/bmjgast-2019-000310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/05/2022] Open
Abstract
Background Various degree of extrinsic compression of the oesophagus and stomach are experienced during upper endoscopy. However, its utility in clinical practice has not been studied. Methods Electronic chart review of all upper gastrointestinal endoscopies done at our hospital between 2005 and 2016 was performed. A total of 79 patients with documented extrinsic compression on upper gastrointestinal procedure report who had a preceding or subsequent abdomen/chest CT imaging performed within 6 months were included. Results 30 (38%) out of 79 patients had abnormal finding on CT scan. 14 (47%) out of 30 patients had an associated malignant lesion, whereas remaining had a benign lesion. Overall, patients with associated gastrointestinal symptoms (60% vs 22%, p=0.001) or history of weight loss (50% vs 16%, p=0.001) had increased odds of having an abnormal finding on CT scan compared with the patients who lacked such symptoms. Pancreatic cancer was the most commonly diagnosed malignancy. On subgroup analysis of patients with extrinsic compression and malignant lesion on imaging study, the likelihood of a malignancy was higher in blacks as compared with Hispanics (71%:29% vs 39%:61%, p=0.031), and with presence of gastrointestinal symptoms (64% vs 22%, p=0.003), presence of weight loss (64% vs 16%, p=0.0001) and hypoalbuminaemia (p=0.001). Conclusion Finding an extrinsic compression of the oesophagus and stomach on an upper endoscopy may suggest malignancy, and hence should prompt further work-up. Posterior wall gastric body compression may signal the presence of pancreatic cancer.
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Affiliation(s)
- Kishore Kumar
- Department of Medicine, BronxCare Health System, Bronx, New York, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, New York, USA
| | - Harish Patel
- Department of Medicine, BronxCare Health System, Bronx, New York, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, New York, USA
| | | | - Hassan Tariq
- Department of Medicine, BronxCare Health System, Bronx, New York, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, New York, USA
| | - Mariela Glandt
- Department of Medicine, BronxCare Health System, Bronx, New York, USA
| | - Mohamad Erfani
- Department of Medicine, BronxCare Health System, Bronx, New York, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, New York, USA
| | - Anil Dev
- Department of Medicine, BronxCare Health System, Bronx, New York, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, New York, USA
| | - Aiyi Zhang
- Department of Medicine, BronxCare Health System, Bronx, New York, USA
| | - Jasbir Makker
- Department of Medicine, BronxCare Health System, Bronx, New York, USA.,Division of Gastroenterology, BronxCare Health System, Bronx, New York, USA
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